Proximal Humeral Fractures

Question 1

Aetiology (proximal humeral fracture)

Answer 1

Fall onto outstretched hand

Fall directly onto shoulder

Question 2

Proximal Humeral Fracture- most common fracture pattern

Answer 2

Surgical neck

Pull of pectorals major displaces humeral shaft

Question 3

Proximal humeral fracture treatment

Answer 3

Internal fixation
(Can cause stiffness, chronic pain or failure of fixation)

Shoulder replacement

• if there is a 3 or 4 part comminuted humeral fracture
• if there is head splitting fracture of the humerus

Question 4

Shoulder dislocation

Answer 4

Anterior shoulder dislocation is more common than posterior

Question 5

Shoulder dislocation aetiology

Answer 5

Anterior

• Excessive external rotational force
• Fall onto back of shoulder

Posterior
- Posterior force on adducted and internally rotated arm

Question 6

Shoulder Dislocation features

Answer 6

Bankart lesion

Axillary nerve is at risk
- loss of sensation in the regimental badge area

Light bulb sign on x-ray (posterior)

Question 7

Shoulder dislocation associations

Answer 7

Fracture of the surgical neck of humerus

Fracture of greater tuberosity

Question 8

Shoulder dislocation treatment

Answer 8

Closed reduction
Under anaesthetic
Sling for 2-3 weeks

Question 9

Hill-Sachs lesion

Answer 9

Posterior humeral head impacts on the anterior glenoid

Question 10

AC dislocation consequences

Answer 10

Coracoclaviuclar and AC ligaments are ruptured

Question 11

AC subluxation consequences

Answer 11

AC ligaments are ruptured

Question 12

AC dislocation/ subluxation treatment

Answer 12

Sling for a few weeks
Physiotherapy
Surgery for chronic pain